Measuring Chronic Pain

The World Health Organization has a "pain ladder" that characterizes cancer pain according to three levels. The levels are mild pain, moderate pain, and severe pain. These general principles can be applied to all types of chronic pain.

Mild pain: Mild pain is self-limited. It goes away either with no therapy at all or with the use of nonprescription medication such as acetaminophen (Tylenol), aspirin, or other nonsteroidal anti-inflammatory drugs (NSAIDs). There are a variety of NSAIDs (examples are Motrin, Advil, and Aleve). Some are available without a prescription. Patients can try different types to find the one that works best for them.

Moderate pain: Moderate pain is worse than mild pain. It interferes with function. The person may be unable to ignore the pain and it interferes with the activities of daily life, but it goes away after a while and doesn't come back after it has been treated. Moderate pain may need stronger medications than acetaminophen or nonprescription NSAIDs. Most NSAIDs, including ibuprofen (Motrin), have been found to be as effective at relieving pain as codeine. A health care professional can work with the patient to find the type of NSAID, either prescription or nonprescription, that works best for the patient.

Severe pain: Severe pain is defined as pain that interferes with some or all of the activities of daily living. The person may be confined to bed or chair rest because of the severity of the pain. Often, it doesn't go away, and treatment needs to be continuous for days, weeks, months, or years. For severe pain, the World Health Organization recommends strong opioids, such as morphine, oxycodone, hydrocodone, hydromorphone, methadone, or fentanyl, as well as other medications (called adjuvant therapies) as needed for the particular kind of pain. A number of adjuvant therapies are described in the previous section.